HOME

TheInfoList



OR:

Health care sharing ministries (HCSM) are organizations in the United States in which
health care costs Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
are shared among members with common ethical or religious beliefs in a risk-pooling framework in some ways analogous to, but distinct from, health insurance. Members of health care sharing
ministries Ministry may refer to: Government * Ministry (collective executive), the complete body of government ministers under the leadership of a prime minister * Ministry (government department), a department of a government Religion * Christian mi ...
are exempt from the
individual mandate An individual mandate is a requirement by law for certain persons to purchase or otherwise obtain a good or service. United States Militia act The Militia Acts of 1792, based on the Constitution's militia clause (in addition to its affirmative ...
requirement of the U.S.
Patient Protection and Affordable Care Act The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presi ...
of 2010 (the
individual shared responsibility provision The individual shared responsibility provision, less formally known as the individual mandate, was the health insurance mandate imposed on individuals by the Affordable Care Act in the United States until tax year 2019. This individual mandate requi ...
was repealed in December 2017, effective in 2019). This means members of health care sharing ministries were not required to have insurance as outlined in the individual mandate, which was later repealed. Approximately 31 states have
safe harbor A safe harbor or harbour is literally a "place of shelter and safety, esp. for ships". It is used in many contexts: Film and television * Safe harbor (broadcasting), established in 1978 in the US, the time period in a television schedule during wh ...
laws distinguishing healthcare ministries from
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
organizations. Some of the larger health care sharing ministries are Christian Healthcare Ministries (founded in 1981), Medi-Share, a program of Christian Care Ministry (1993), Samaritan Ministries (1994), Liberty HealthShare (1998, originally established by
Mennonites Mennonites are groups of Anabaptist Christian church communities of denominations. The name is derived from the founder of the movement, Menno Simons (1496–1561) of Friesland. Through his writings about Reformed Christianity during the Radic ...
), United Refuah HealthShare, MCS Medical Cost Sharing Altrua HealthShare, Freedom HealthShare, Unite Health Share Ministries, and Trinity HealthShare (1997).


History

Predecessors to health care sharing ministries date back to at least the early 1900s. For many decades, "in
Amish The Amish (; pdc, Amisch; german: link=no, Amische), formally the Old Order Amish, are a group of traditionalist Anabaptist Christian church fellowships with Swiss German and Alsatian origins. They are closely related to Mennonite churches ...
and
Mennonite Mennonites are groups of Anabaptist Christian church communities of denominations. The name is derived from the founder of the movement, Menno Simons (1496–1561) of Friesland. Through his writings about Reformed Christianity during the Radic ...
communities across the S people pooled their money to lighten the burden of debt for individuals during hard times." In the late 20th century, this broadened out to larger communities by larger cost-sharing ministries within the Christian community. Most health care sharing ministries are oriented toward practicing
Christians Christians () are people who follow or adhere to Christianity, a monotheistic Abrahamic religion based on the life and teachings of Jesus Christ. The words ''Christ'' and ''Christian'' derive from the Koine Greek title ''Christós'' (Χρι ...
and aligned with ideals or principles found in the Christian
Bible The Bible (from Koine Greek , , 'the books') is a collection of religious texts or scriptures that are held to be sacred in Christianity, Judaism, Samaritanism, and many other religions. The Bible is an anthologya compilation of texts of a ...
, primarily translated to mean believers have a responsibility to assist in meeting each other's needs. Such ministries often cite a biblical verse in the book of
Galatians Galatians may refer to: * Galatians (people) * Epistle to the Galatians, a book of the New Testament * English translation of the Greek ''Galatai'' or Latin ''Galatae'', ''Galli,'' or ''Gallograeci'' to refer to either the Galatians or the Gauls in ...
, from the
New Testament The New Testament grc, Ἡ Καινὴ Διαθήκη, transl. ; la, Novum Testamentum. (NT) is the second division of the Christian biblical canon. It discusses the teachings and person of Jesus, as well as events in first-century Christ ...
, as a mandate applicable to medical costs, specifically Verse 2 in Chapter 6, in which the
Apostle Paul Paul; grc, Παῦλος, translit=Paulos; cop, ⲡⲁⲩⲗⲟⲥ; hbo, פאולוס השליח (previously called Saul of Tarsus;; ar, بولس الطرسوسي; grc, Σαῦλος Ταρσεύς, Saũlos Tarseús; tr, Tarsuslu Pavlus; ...
said "Bear one another's burdens, and thus fulfill the law of Christ." Some ministries view verses 44–45 in Chapter 2 of the
Book of Acts The Acts of the Apostles ( grc-koi, Πράξεις Ἀποστόλων, ''Práxeis Apostólōn''; la, Actūs Apostolōrum) is the fifth book of the New Testament; it tells of the founding of the Christian Church and the spread of its message ...
, also from the New Testament, which states that early Christians "were together and had everything in common" and "gave to anyone as he had need," as the basis for their founding. Other health cost-sharing organizations are more secular. For example, Sedera Health asks their members to "live a healthy lifestyle" but does not explicitly emphasize any religious obligations. Several states have tried to block health care sharing ministries on the grounds that they are selling unauthorized insurance.. For example, the
State of Oklahoma Oklahoma (; Choctaw: ; chr, ᎣᎧᎳᎰᎹ, ''Okalahoma'' ) is a state in the South Central region of the United States, bordered by Texas on the south and west, Kansas on the north, Missouri on the northeast, Arkansas on the east, New M ...
contested Medi-Share in 2007 for marketing information that promoted the cost-sharing option as "insurance", but that issue was resolved when they changed their approach, and by 2010, Medi-Share was able to operate in Oklahoma once again. A majority of states, however, have enacted safe harbor laws specifying that the ministries are not insurance and do not need to be regulated as such. In addition, the U.S. Department of Health and Human Services issues exemption letters to ministries that have met the criteria to operate independently of the Affordable Care Act. In 2010, at the time the U.S. Patient Protection and Affordable Care Act was passed, there were estimated to be about 100,000 people belonging to some type of medical bill-sharing ministry. By 2014, it was estimated to be 160,000; and by 2018, that number in the US had grown to 1 million. The future of health care sharing ministries after Obamacare's individual mandate repeal was unclear, but a work published by Harvard Law School suggested that many people may continue to use them, and they could even expand for people ineligible for healthcare subsidies (i.e. above the income threshold).


Membership

According to Alliance of Health Care Sharing Ministries, a
trade association A trade association, also known as an industry trade group, business association, sector association or industry body, is an organization founded and funded by businesses that operate in a specific Industry (economics), industry. An industry tra ...
of sharing ministries, over 1 million Americans participated in health care sharing , sharing more than $670 million in medical bills annually. A January 2015 op-ed in ''The New York Times'' stated that the four main healthcare ministries in the US have a total combined membership of about 340,000, that membership has grown significantly because of the healthcare ministries' exemption to the insurance mandate of the Affordable Care Act, and that monthly cost of membership in a health care sharing ministry is generally lower than the cost of insurance rates. ''The Seattle Times'' also reported that membership had grown significantly, in a 2015 article. Most health sharing ministries tend to have restrictions. They usually require members to be in good health and make a statement of belief, as well. For instance, Samaritan Ministries requires a statement of Christian faith including belief in the true God and divinity of Jesus; Liberty HealthShare and Freedom HealthShare are more inclusive, accepting members with a wide variety of religious and ethical beliefs. All such ministries require that members subscribe to the principles of individual responsibility for their own health and of helping others in need.


Requirements under the Affordable Care Act

In order for members to be exempt from the tax penalties outlined in the Affordable Care Act, ministries must meet the following qualifications: * Must be a
501(c)(3) A 501(c)(3) organization is a United States corporation, trust, unincorporated association or other type of organization exempt from federal income tax under section 501(c)(3) of Title 26 of the United States Code. It is one of the 29 types of 50 ...
organization * Members must share common ethical or religious beliefs * Must not discriminate membership based on state of residence or employment * Members cannot lose membership due to development of a medical condition * Must have (or a predecessor must have) existed and been in practice continually since December 31, 1999 (a grandfather clause) * Must be subject to an annual audit by an independent CPA which must be publicly available upon request The five ministries that meet these qualifications are: Christian Healthcare Ministries, Liberty HealthShare, Medi-Share, Samaritan Ministries, OneShare. MCS Medical Cost Sharing, founded after 1999, does not meet the qualifications, but offers to pay the tax penalties incurred by members. Altrua HealthShare has also been recognized as a qualifying health care sharing ministry, due to its merger with Blessed Assurance Bulletin. Anabaptist Healthshare is recognized as a health care sharing ministry by the U.S. Department of Health & Human Services. In 2017, a healthcare sharing organization tailored to Jews, United Refuah, was launched. The group claims to be recognized as a healthcare sharing organization by the Centers for Medicare & Medicaid Services (CMS).


Tax deductibility

Monthly share payments are not deductible from US federal income tax as either a medical expense (because it is not a payment for insurance) or a charitable deduction (because it is a payment for goods and services). Member payment in excess of their required monthly minimum, however, may be deductible as a charitable contribution. In a proposed rule, dated June 8, 2020 the IRS has proposed to change the deductibility of share payments.


Criticism

Health insurance brokers in Massachusetts are not allowed to market health care sharing ministry memberships to consumers, to avoid misleading consumers into thinking they are low-price guaranteed-issue insurance plans. HCSMs are not required to cover pre-existing conditions, which has led to disputes over denial of payment. In 2020, the
California Department of Insurance The California Department of Insurance (CDI), established in 1868, is the agency charged with overseeing insurance regulations, enforcing statutes mandating consumer protections, educating consumers, and fostering the stability of insurance marke ...
issued a cease and desist order to Aliera Healthcare, Inc., and Trinity Healthshares, Inc., founded by Timothy Moses and his wife Shelley Steele, for violating California law by misleading California consumers into purchasing their products. It is estimated that Aliera and the Moses family pocketed 84% of member monthly plan sharing, allowing for up to 16% to be invested into the healthcare sharing ministry fund and drawing much criticism, as Affordable Care Act health plans require up to 80% of premiums to be paid towards medical plans. In June 2021 comedian John Oliver set up a healthcare sharing ministry in Florida called ''
Our Lady of Perpetual Health Our Lady of Perpetual Exemption was a legally recognized church in the United States, established by comedian and satirist John Oliver. Its purpose was to expose and ridicule televangelists such as Robert Tilton and Creflo Dollar who preach the ...
'' (following his earlier satire ''Our Lady of Perpetual Exemption''), satirizing what HCSMs are allowed to do by law, essentially having no obligation to provide any care. (*The Web site clarifies that ''no'' needs are actually eligible.)


See also

*
Benefit society A benefit society, fraternal benefit society, fraternal benefit order, friendly society, or mutual aid society is a society, an organization or a voluntary association formed to provide mutual aid, benefit, for instance insurance for relief fr ...


Notes


References


Further reading

* * * * * * (o
via EBSCO
* * * * * * *
As published
with advertising) * * * * * * * *


External links

* {{cite web, last=Brase , first=Twila , date=1 April 2010 , orig-year=2009 , title=Medical Sharing Ministries (MSM): Comparison chart , publisher=Citizens’ Council on Health Care , url=http://www.cchfreedom.org/pdf/MEDICAL_SHARING_MINISTRIES-COMPARISON_CHART.pdf
Alliance of Health Care Sharing Ministries
Healthcare cost sharing organizations Health policy in the United States